This proposal is to conduct an evaluation of the "Rewarding Results" program, the overall aim of which is to invent, test, and diffuse innovations that fully align both payment systems and nonfinancial incentives with the provision of high-quality care. Organizations selected for the program will conduct demonstrations of innovative payment/ incentive systems for the purpose of improving quality of care. A primary evaluation team will conduct an overall assessment of the success of the program. The long-term objective of this proposed evaluation is to improve quality of care by contributing to our understanding of the potential linkages between payment/ incentive systems for providers and quality of care. The specific aims of the evaluation project are the following: 1) to determine for grantee organizations the extent to which the anticipated quality goals are actually achieved, 2) to identify the primary factors that either contributed to the achievement of the quality goals or prevented achievement of those goals, 3) to understand the factors underlying grantee's decisions about how to design and implement their systems of payments and incentives and the implications of those decisions for the success of the systems, and 4) to determine the extent to which, and the ways in which, initial successes achieved through "Rewarding Results" are diffused beyond the demonstration setting. The evaluation will utilize several types of research designs including quasi-experimental, comparative case, and observational methodologies. Data for the evaluation will be collected though site visits to grantee organizations, surveys of selected individuals who are the target population for the grantee organization's payment/ incentive systems, and documents, reports and other sources of secondary data. The primary evaluation team will analyze the qualitative and quantitative data that are obtained through data collection on these activities to assess the success of the "Rewarding Results" program in relation to fostering innovative payment/ incentive systems that can be diffused to improve the quality of care that is delivered in the U.S.